All Entries Tagged With: "communication"
Discharge planning: It’s not the patient’s job
About a year ago, I went to the ED with stomach pain. Luckily, it wasn’t anything a round of antibiotics and some rest couldn’t take care of. When I saw my PCP a week later, I was surprised (and a little impressed) that she was up to speed—she knew what tests the hospital ran and my diagnosis, which enabled her to deliver appropriate follow-up care. But should we, as patients, be surprised or impressed when our PCPs and those who care for us in the hospital communicate with each other effectively? Personally, I think good hospitalist-PCP communication should be a given.
Is primary care losing its appeal?
Last week, we wrote about how one PCP said that the hospitalist movement could have a devastating effect of primary care since fewer residents and medical students were choosing careers in primary care.
Here are some other reasons why PCPs might not refer their patients to hospitalists.
When PCPs choose to refer patients to a hospitalist program, it’s a mixed bag. These referring PCPs may be able to extend their office hours or eliminate the daily drive to the hospital, but jumping on the hospitalist bandwagon leaves some PCPs feeling nostalgic for the good old days when they followed their patients throughout their hospitalization. Consider these drawbacks: [more]
Hospitalists coordinate communication, cut costs, and reduce LOS, new study says
The hospitalist model produces better patient outcomes, according to a study, "Is the doctor in? A relational approach to job design and the coordination of work," published in winter 2008 issue of Human Resource Management.
As the first research to link job design (education, consulting, healthcare) to outcomes, the study evaluated the effects of stage and site-based physician specialization on coordination and performance outcomes, according to the abstract.
Studying more than 6,000 cases at the Newton-Wellesley Hospital, MA during July 2001 to July 2003, researchers found that the hospitalist model was linked to the following results:
- Reduced length of stay by about half a day
- Cut hospital costs by $655 per patient
- Reduced the risk of readmission by nearly 42%
- Improved coordination of communication between physicians and other care providers by more than 13%
Why use a Web log
To ensure patient safety and continuity of care, hospitalists must not only establish strong communication links with PCPs, specialists, and patients, but also with other hospitalists in the program, nurses, and other providers. For hospitalist programs spanning multiple hospitals and numerous sites, this process becomes even more complex.
As a result, some hospitalist programs are turning to electronic means of communication: Web logs, patient “portals,” and other sites that update all parties on a patients’ status.
When a patient is discharged, the patient’s PCP can access the discharge summary on the Web log to view:
- Patient demographic information
- Brief summary of why the patient was admitted
- Patient’s discharge date, disposition, and follow-up appointment times
Staff at the outpatient sites should have “read only” access to the Web log to just view and print patient information for use when the patient returns to the outpatient office for a follow-up. Clerical staff should update and maintain the patient information and physician schedules daily. This information is considered a communication tool and not part of the patient record.
The above excerpt is adapted from Tools and Strategies for an Effective Hospitalist Program, by Jeffrey R. Dichter, MD, FACP and Kenneth G. Simone, DO, published by HCPro, Inc.
Improve communication with PCPs
Inpatient and outpatient providers depend on each other to optimize patient care and clinical outcomes, but that relationship comes with challenges. The downfall of many hospitalist programs isn’t necessarily poor-quality care. Rather, a failed program might result from lack of planning, lack of infrastructure, and unmet expectations on the part of customers (patients and referring providers/PCPs).
Conversely, the success of the practitioners’ partnership comes from the careful planning and implementation of the hospitalist program. Develop an integrated delivery system that is complete with policies, procedures, and protocols, assigning responsibilities to each side of process. Some hospitalist deliverables include the following protocols:
- Give referring physicians and PCPs patient brochures that explain the hospitalist program and services provided. Have the referring physicians and PCPs place patient brochures in their office waiting rooms.
- Make confirmation calls to the PCP on the day of admission. If the admission occurs after hours or on a weekend or holiday, call on the next business day.
- Transmit admission history and physical exam results to the referring provider/PCP within one hour of evaluation.
- Call the PCP with updates and significant changes in the patient’s status.
- Involve the PCP in any major diagnostic or treatment plans.
- Coordinate a discharge plan with the PCP.
- Coordinate a patient/family conference before discharge to answer questions, review the discharge medications, and outline the outpatient treatment plan.
- Transmit a summary discharge sheet to the PCP stating discharge diagnosis, discharge medications, and follow-up recommendations.
- Provide priority dictation and transmit discharge summary to PCP within three hours of patient discharge.
- Follow-up with the patient by telephone within 24 hours of discharge.
The above excerpt is adapted from Hospitalist Case Studies: Tactics and Strategies for 10 Common Hurdles, by Kenneth G. Simone, DO, published by HCPro, Inc.
